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General NPI Number Information
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NPI Number | 1760727358
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Entity Type | Organization
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Legal Business Name | MAINELY EYES
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Dates
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Enumeration Date | 12/07/2012
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 663 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3645
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Country | US
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Telephone | 207-945-3937
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Fax | 207-945-3920
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Provider Business Mailing Address
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Address Line | 663 STILLWATER AVE
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City | BANGOR
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State | ME
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Zip | 04401-3645
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Country | US
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Telephone | 207-945-3937
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Fax | 207-945-3920
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHILIP GOLDTHWAIT
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Credential | O.D.
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Telephone | 207-945-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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